<html>
  <head>
      <meta http-equiv="Content-Type" content="text/html; charset=utf-8"> 
      <meta name="viewport" content="width=device-width,initial-scale=1.0,minimum-scale,maximum-scale=1.0,user-scalable=no"/>
      <link rel ="stylesheet" type="text/css" media="screen and(max-device-width:400px)"href="tinyScreen.css">
      <link rel ="stylesheet" type="text/css" media="screen and(min-width:400px)and(max-device-width:600px)"href="smallScreen.css">
      <link rel ="stylesheet" type-"text/css" href="css/lilincss.css">
  </head>
    <body >
      <div class="wrapper">
         <section id="getintouch" class="bounceIn animated">
           <div class="container" style ="border-bottom: 0;">
            <h1 style="color:antiquewhite;font-size:100%;background-color:black"> 
             <span class="arrow-outer"> < </span>
             <span> 全国救援卡激活</span>
           </h1>
         </div>
         <div class="row clerafix">
            <form>
              <span style="color: red">*</span>
              <span>会员姓名：</span>
              <input type="text" name=" mingzi">
            </form>
          </div>
          <div class="row clerafix">
              <form>
                <span style="color: red">*</span>
                <span>会员性别：</span>
                <input name="radiosex1" type="radio"checked  value=""/>男</input>
                <input name="radiosex1" type="radio" value =""/>女</input>
              </form>
            </div>
            <div class="row clerafix">
                <form>
                  <span style="color: red">*</span>
                  <span>会员电话：</span>
                  <input type="text" name=" 电话">
                </form>
              </div>
              <div class="row clerafix">
                  <form>
                    <span style="color: red">*</span>
                    <span>会员卡号：</span>
                    <input type="text" name=" kahao">
                  </form>
                </div>
                <div class="row clerafix">
                    <form>
                      <span style="color: red">*</span>
                      <span>身份证号：</span>
                      <input type="text" name=" shenfenzhenghao">
                    </form>
                  </div>
                  <div class="row clerafix">
                      <form>
                        <span>会员血型：</span>
                        <select>
                          <option value="A型">A型</option>
                          <option value="B型">B型</option>
                          <option value="O型">O型</option>
                        </select>
                      </form>
                    </div>
                    <div class="row clerafix">
                        <form>
                          <span>病史：</span>
                          <input type="text" bingshi=" bingshi">
                        </form>
                      </div>
                      <div class="row clerafix">
                          <form>
                            <span style="color: red">*</span>
                            <span>紧急联系人：</span>
                            <input type="text" name=" jinjilianxiren">
                          </form>
                        </div>
                        <div class="row clerafix">
                            <form>
                              <span style="color: red">*</span>
                              <span>紧急联系人电话：</span>
                              <input type="text" name=" tel">
                            </form>
                          </div>
                          <div class="row clerafix">
                              <form>
                                <span style="color: red">*</span>
                                <span>保单号：</span>
                                <input type="text" name=" baodanhao">
                              </form>
                            </div>
                            <div class="row clerafix">
                                <form>
                                  <span style="color: red">*</span>
                                  <span>保险公司：</span>
                                  <input type="text" name=" baoxiangongsi">
                                </form>
                              </div>
                              <div class="row clerafix">
                                  <form>
                                    <span style="color: red">*</span>
                                    <span>车牌号：</span>
                                    <input type="text" name=" chepaihao">
                                  </form>
                                </div>
                                <div class="row clerafix">
                                    <form>
                                      <span style="color: red">*</span>
                                      <span>VIN码：</span>
                                      <input type="text" name=" VIN码">
                                    </form>
                                  </div>
                                  <div class="row clerafix">
                                      <form>
                                        <span style="color: red">*</span>
                                        <span>发动机号：</span>
                                        <input type="text" name=" fadongjihao">
                                      </form>
                                    </div>
                                    <div class="row clerafix">
                                        <form>
                                          <span style="color: red">*</span>
                                          <span>保险代理公司：</span>
                                          <input type="text" name=" baoxiandailigongsi">
                                        </form>
                                      </div>
                                      <div class="row clerafix">
                                          <form>
                                            <span style="color: red">*</span>
                                            <span>会员卡号：</span>
                                            <input type="text" name=" shenfenzhenghao">
                                          </form>
                                        </div>
                                        <div class="row clerafix">
                                            <form>
                                              <span style="color: red">*</span>
                                              <span>会员卡密码：</span>
                                              <input type="text" name=" shenfenzhenghao">
                                            </form>
                                          </div>
                                          <div >
                                              <button type="submit" name="submit" id="submit">激活</button> 
                                          </div>
       </section>
      </div>
    </body>   
    </html>
    